Individual
MIRANDA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
449 S FITNESS PL, EAGLE, ID 83616-6828
(208) 957-6301
Mailing address
2920 W JEFFERSON ST, BOISE, ID 83702-4614
(208) 249-4890
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
04/24/2021
Last updated
04/24/2021
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